Denied No More: ACA Requires Coverage for Pre-Existing Conditions

October 28, 2013

The Affordable Care Act (ACA) has revolutionized the health insurance world, and made health care available to a group of Americans who previously couldn’t obtain or afford it.

In the past, insurance carriers could deny coverage to those with pre-existing conditions, which meant leaving those who needed health care the most out in the cold. With the implementation of the ACA, pre-existing conditions are no longer a concern. Everyone can get health insurance, regardless of past or present diseases, illnesses or injuries.

Why Deny Coverage?

The insurance companies had their reasons for denying those with pre-existing conditions. It can be incredibly expensive to insure someone with a high likelihood of needing extensive care. Frequent hospitalizations, pricey medications, and high-tech surgical procedures often cost insurers far more than they could realistically collect in premiums.

Pre-ACA, insurance companies would use a process called underwriting to determine a person’s likelihood of needing significant medical care. Looking at someone’s past medical history was considered a indicator of his or her future health. The ACA eliminates that process, ensuring that everyone has access to quality health care insurance.

As of January 1, 2014, most Americans will be required to have health insurance, and those who don’t comply will be fined a flat amount. It would be virtually impossible to mandate health insurance and fine those who were unable to comply with the law due to pre-existing conditions, which is why the ACA forbids insurance companies from denying coverage to anyone.

Conditions Now Covered

A pre-existing condition is defined as any health condition treated or diagnosed within the past 12 months. Under this definition, even pregnancy could be — and often was — considered a pre-existing condition prior to the ACA. Some insurance companies offered individual coverage, but excluded the pre-existing condition from the policy; others issued an outright denial.

Under the ACA, any and all conditions are covered, included but not limited to:

  • AIDS

  • Cancer

  • Heart disease

  • Diabetes

  • Heart attacks

  • Parkinson’s disease

  • Organ transplants

  • Psychiatric disorders

  • Cystic Fibrosis

  • Pregnancy

  • Pending surgery

If you’ve been denied health insurance for these or any other condition, your struggles are at an end.  Contact us today and let Terpening Insurance help you take advantage of the ACA and get you the health insurance you need and deserve!

If you’d like to know more about the scope of the changes included with the ACA, please take a look at our comprehensive guide to the new system, Covered California: Everything You Need to Know.

Post author Loren Pleet